Intimate Partner Violence and Sexual Assault

Survivors of intimate partner violence (IPV) and sexual assault in particular require sensitive abortion counseling, options counseling, and a full range of sexual health care. Counseling and providing care for individuals experiencing intimate partner violence or sexual assault involves prevention, detection through routine screening, counseling and follow-up, which can include referrals to community IVP and sexual assault programs (see resources below).1

Survivors of Intimate Partner Violence

Research shows that persons experiencing IPV may be more likely to have an abortion.2,3 These inviduals may seek an abortion after having their birth control sabotaged, after being sexually assaulted, or after leaving an abusive relationship in fear of a former partner harming her or a future child.3 Another recent study found that 8% of people cited one of the reasons they sought abortion was because their partner was abusive.4 Individuals described fears that abuse would continue if they had a child and also that having a child might prevent them from leaving the abusive relationship.

Partners may also coerce or threaten someone to push them to seek abortion or harm them in attempts to cause abortion. While this appears to be infrequent, providers counseling individuals seeking abortion should also be aware of this concern.4

Survivors of Sexual Assault

Eighteen percent of American women experience rape or attempted rape in their lifetimes, and nearly 80% of women reported that they were first raped before age 25 years, and 42% before age 18 years.5,6,7 Up to 5% of rapes result in pregnancy.8 Data from 2005-10 suggests that 78% of sexual violence involves an offender who was a family member, intimate partner, friend, or acquaintance.9 Thus, IPV and sexual assault often co-exist.

Counseling Recommendations

It is important to recognize that abortion care may be a person's first entry into health care since the assault so providers should also assess her post-assault mental and physical health. However, individuals who are pregnant as a result of sexual assault may not disclose this information. If they do, referrals for mental health services should be available and offered, and testing for sexually transmitted infections should be recommended.10 Rape survivors may be working with a crisis advocate, through an organization such as Rape Victims Advocates, and the advocates may attend clinical visits. If she does not have an advocate, a referral to this agency may be offered to her.

Survivors of sexual assault are more likely to exhibit symptoms of depression, PTSD, substance abuse, and suicidal thoughts. Some may blame themselves for the assault. Vaginal ultrasounds, gynecological exams, and surgical abortions may trigger a stress response that requires sensitive patient-centered care. Providers should not assume that survivors seeking abortion services accept their decision easily. 

Legal Considerations

Products of conception may be used as forensic evidence if the person is pressing charges against the assailant, and all individuals who have experienced a pregnancy resulting from rape should be made aware of this option. Communication with law enforcement so that the products of conception may be handled consistent with chain of evidence procedures is of utmost importance.10